840 Audit Cycle of Surgical Management of Traumatic Open Hand Wounds at BRI – Compliance with BSSH Guidelines

Aim To assess whether the Plastic Surgery Department at Bradford Royal Infirmary are compliant with BSSH guidelines regarding timing of surgery for open soft tissue hand traumas (target rate 100%). Method Two retrospective data collection sets between 11th October 7th November 2021 and 7th March to 3rd April 2022 using Bradford’s Electronic Patient Records (EPR) and Xero PACS to review Plastic Trauma Clinic (PTC) clerking notes; Operation notes and Clinic letters. Patients included were all adult patients attending PTC with open soft tissue injuries needing definitive surgical treatment in an operating theatre/PTC. Results The initial study found a compliance rate of 74%, with a 62.5% compliance when it was the patient’s dominant hand. The number of individual soft tissues for repair was 14 for Flexor Tendon (FT), 17 for Extensor Tendon (ET) and Digital Nerve (DN) with compliance rates of 83.3% for FT and 76.4% for both ET and DN. The repeat cycle found an overall compliance of 72% with 62.5% for FT and DN and 81.5% for ET. Conclusions The main reason for non-compliance was due to hospital bed capacity and a lack of list space. Recommendations to improve theatre efficiency was made but despite this the same issues presented in the 2nd cycle. There was a total of 69 days of delay from the initial operation date, resulting in 17 overnight stays. Further recommendations to accurately plan allocated theatre time and not rely on the acute list to reduce cancellations have been made with a view to re-assess.